RESEARCH REPORT 4 Paid Care Workers in Tanzania:

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Supporting the dispensaries are health centres. These are supposed to give priority to preventive measures and hygiene education but in reality they are extensively used for treatment of common diseases. Most of the health centres have room for minor surgery and provide 20-30 beds for in patients including maternity cases. A health centre is run by a Medical Assistance (M.A) with secondary education with more elaborate education in diagnosis and treatment as well as training in minor surgery. This is of higher grade then the rural medical aid. The medical assistant is normally assisted by one or two rural medical aids, a nurse/midwife with one or two maternal and child health aids and health assistant. In the continuum of care the Medical Assistant would provide treatment to the PLWHA who has been referred to by the RMA. The PLWHA might be admitted for treatment or for further diagnoses. Above the health centre there is a district hospital. This is the base for staffing and supplying all rural units with equipment, and medicine. Generally, there is one district hospital per administrative unit and it is the district hospital that any difficult or serious case is referred to from the lower levels. The district hospitals are provided with medical doctors one or more depending on the size, stores for drugs and equipment, and a diagnostic laboratory, ex ray, operation facilities and beds for referred patients. Each district has a Health Management Team (DHMT). The DHMT is expected to mainstream HBC services in the health services. Above the district is a regional hospital. Strictly the regional and district hospitals are similar except that the regional hospital has more facilities and more highly skilled health personal that is 5-10 doctors including one specialist. The highest level is the national referral hospitals, endowed with more sophisticated equipment, more specialists, and more staffing across all cadres. The HBC program is premised on the assumption that a functional referral system is in place, and that resources for HIV&AIDS will trickle down to the households with PLWHAs particularly the poorest households. Additionally, it is further assumed that there will be individuals within and outside the households who will be willing to volunteer to provide needed care for the bedridden patients in their households. Although the HIV&AIDS is supposed to be multi sectoral, the care services highly depend upon the health care facilities. This seems to have overstretched the human resource capacities of the health facilities which were already experiencing a human resource crisis. One of the major challenges limiting the implementation of health policies and particularly the HIV&AIDS programmes including care and treatment is lack of qualified human resources in the health sector. While data on the size of health workers by category is not easily available in Tanzania, all existing literature and political pronouncements indicate a human resource crisis in the health sector. The CMI report (2006) asserts that Tanzania has the word’s lowest coverage of physicians, with only 0.02 medical officers or specialist per 1,000 persons (CMI: 2006: 4). Additionally, at a Joint Health Sector Review in 2004, the Permanent Secretary of Ministry of Health declared that in …. “the area of human resources, I believe we have now reached a crisis point”. At the Annual Review of 2005, Minister of Health asserted that the crisis now has reached emergency proportions. In his address to the Regional Medical Officers in 2005, the then President of the United Republic of Tanzania His Excellency Benjamin Mkapa is quoted to have said” the shortage of health personnel … “is a serious problem, which requires urgent steps.” (CMI report: 2006: 9). According to the Human Resource Health (HRH) census in 2001/02, the size of active supply of health workers was 49,900 (MoH: 2004), which translates into staff per population ratio of 148 per 100,000. In 1994/95, active supply was approximately 67,600 health workers (census 4
1994/95). Hence active supply decreased by 19,300 health workers over the period between 1994/95 and 2001/02 ( Dommick and Karowski: 2005). The authors further claim that given the conservative assumption about increments and attrition, the size of the total workforce will continue to decline to approximately 37,900 by 2015 (ibid) . The human resource crisis notwithstanding, the HIV&AIDS pandemic and particularly the implementation of the Care and Treatment programmes has increased the demand for human resources for health sector across all categories of health workers. McKinsey study (2004) estimated that the Tanzanian HIV&AIDS care and treatment plan will require almost 10,000 full time health workers. Dominick A and Kurowski C (2004) study further claim that more than 25% of all the health services are provided to patients infected with the virus. These authors further asserted that further increase of this share was expected with the implementation of the NCTP for PLWHA. The Plan had set a target of treating 65,000 PLWHA with antiretroviral drugs (ARVs) by the end of 2005, and at least 400,000 by the year 2008. The WHO suggests an even more ambitious scaling up of care and treatment, aiming to treat 220,000 PLWHA with ARVs by the end of 2005 (MoH, 2003). If the NCTP was to be implemented fully, it was expected that the demand for health workers would have significantly grown. The provision of antiretroviral treatment to approximately 500,000 PLWHA in 2008 would require approximately 9,300 FTEs (URT 2003). In disaggregating the shortage of health cadre by skill, the CMI report (2006) compares the actual staffing levels to the staffing norms, in which the greatest shortage was found among Assistant Medical Officers/clinical officers and lab technicians (60%) followed by nursing cadre (50% and doctors (40%) (CMI report: 2006: 23). To make matters worse, the distribution of the health workers is skewed in favour of the higher levels of health services which are not easily available to the majority of people in the rural communities. This is demonstrated in the following table. Health Facility FTEs Proportion of the total Health Facility No of Staff % of total Hospitals 24554 55% Health Centres 5917 13% Dispensary 14284 32% Total 44755 100 Source Census data 2001/02 In a nutshell, there is a serious shortage of human resource in health sector which has impacted all health workers generally. When there is a shortage of skilled human resource, the nursing cadre seem to shoulder a disproportionate burden of care This is the context within which health workers supporting the HIV&AIDS pandemic in treatment and care are expected to deliver quality services including the HBC which heavily rely on the health sector workers.. In the following section we discuss briefly the nursing cadre as it relates to the HBC programme. Nursing Cadre and HBC Services Data on the actual size of the nursing cadre is not systematically compiled and hence it is difficult to determine the actual gap in this category. But data compiled by the Tanzania Nurses and Midwives Council (TNMC) suggests that as of July 2007, the country had a total of 20,115 nurses out of whom 7,254 had diploma and higher levels and 12,861 were certificate holders (TNMC: 2008). These data contradict data provided by the shadow Minister of Health from the opposition camp during the 2007/08 budget. He claimed that 5
Page 1 and 2: RESEARCH REPORT 4 Paid Care Workers
Page 3: Introduction Home Based Care servic
Page 7 and 8: hospitals which were included in th
Page 9 and 10: policies that discourage labour mob
Page 11 and 12: these care givers who are doing thi
Page 13 and 14: are either child headed households
Page 15 and 16: Case Study 2: Hamis Ismail Hamis is
Page 17: References Anna Dominick and Christ

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